MILWAUKEE -- Medicare fraud is a multi-billion dollar industry, and many of the scammers want people to buy unnecessary at-home medical equipment.
Ramona Schwan said she was getting five or six calls day from a person claiming to be from Medicare.
"He would say, 'This is Steve from Medicare. Would you like -- would you need a back brace?'" Schwan recalled. "I felt like I was being harassed with all these phone calls."
Schwan had her share of medical issues over the last year, but she said her back wasn't one of them.
"Even saying, 'No, I didn't want it,' about a week later, I got this box in the mail with everything I didn't want in it," she said.
Inside the box, Schwan received a back brace and shoulder sling.
"Then there was a letter inside that says, 'When you get this, call us.' I did," she said.
Schwan asked to send it all back and said the company promised to send return labels. A month later, she still didn't have them, but the company did manage to send Medicare a bill.
"They did end up paying over $1,400 for something I didn't want," Schwan revealed.
A spokesperson for the Centers for Medicare and Medicaid Services (CMS) sent the following statement:
"Medicare Part B (Medical Insurance) covers medically necessary arm, leg, back, and neck braces under the Durable Medical Equipment (DME) prefabricated orthotics benefit. Medicare will only cover DME if the beneficiary’s doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If the doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. CMS does not publicly provide information on ongoing investigations including information about specific suppliers. CMS is aware of the ongoing fraudulent activity and we are working with our contractors, law enforcement, and other stakeholders to address the matter where appropriate."
Ingrid Kundinger of Senior Medicare Patrol said Medicare fraud is common.
"Unfortunately, it's very widespread not only in the state of Wisconsin, but also across the country," she said.
Kundinger explained Medicare will only ever contact you by U.S. mail.
"If you pick up the phone and someone says, 'It's Medicare.' You can simply hang up the phone," she said.
The caller may claim you aren't utilizing all your medical benefits or the order won't cost you a thing. In addition, you may be asked to confirm your Medicare number.
"Never give that information over the phone to anyone," Kundinger advised.
Contact 6 called the medical equipment supplier. A man claiming to be a manager said it was not a scam, but a mistake at best. The person said Schwan should be able to return the equipment. Schwan said she never wanted or needed a back brace.
"We finally had to turn off our phones and change the number," Schwan said. "I'm sorry, but I think they need to be prosecuted. They need to be put out of business is what I'd like to see."
Medicare only covers durable medical equipment that is medically necessary with a doctor's prescription. In some scams, companies will have a doctor willing to sign orders despite never having met with a patient. If you suspect medical fraud to Medicare, you're encouraged to report it.
A CMS spokesperson offered the following advice:
- Don’t accept anything over the phone and send unrequested braces back Return to Sender;
- If you need a brace talk to your primary care doctor
- Enter your phone number on the Do Not Call Registry https://www.donotcall.gov
- Medicare will NEVER contact you uninvited for your Medicare number or other personal information
Medicare encourages all beneficiaries to protect themselves and Medicare against fraud by reviewing their Medicare claims for errors, looking for other types of fraud, and reporting anything suspicious to Medicare. Beneficiaries are encouraged to report suspected Medicare fraud in any of these ways:
- Call Medicare at 1-800-MEDICARE (1-800-633-4227)
- Report it online to the Office of the Inspector General
- Call the Office of the Inspector General at 1-800-HHS-TIPS (1-800-44708477)